Sample Record for 2022-11-02-14
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993510 DEA: 120P9204 EFIS: 1216000044
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-38.5/41.6
Work Description: PLANTING, IRRIGATION, ROCK BLANKET, MINOR CONCRETE AND AC PAVING.
Location Description: ORANGE COUNTY IN ANAHEIM FROM SANTA ANA STREET OVERCROSSING TO 0.5 MILE NORTH OF LA PALMA AVENUE OVERCROSSING
Contractor Name: ACCU CONSTRUCTION, INC.
Contractor Address: 14751 Plaza Drive, Suite L, Tustin , CA 92780
Resident Engineer: Arezo Ghiam Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-11-02-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Concrete
Sample Taken Date: 11/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/03/2022
The quantity of what the sample constitutes: 10 cubic yards
A brief description of the sample: 3/8" rock & Sand
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-1122
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons-Anaheim
Material Information
The concrete mix design number: RRM16044
The truck number from where the sample was collected: 1997
The batch plant ticket number from where the sample was collected: 101C705872
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
